This paper examines the inability of a divided society to respond to public health challenges, and the implications of accelerated national spread of emerging infection.
AUTHORS: Rodrick Wallace; Kristin McCarthy
PUBLISHED: Environment and Planning 2007.
Empirical techniques adapted from ecosystem-resilience theory allows estimation of how public health and public order within the New York Metropolitan Region respond to perturbations driven by changes in policy and economic structure. This approach constitutes a rigorous methodology for health-impact assessment, providing a quantitative measure of the stability of the region. Contrary to entrenched cultural assumption, affluent suburban counties and impoverished central-city neighborhoods remain strongly linked through a probability-of-contact matrix well indexed by the daily journey to work. The public-health ecology of the New York Metropolitan Region is remarkably unstable, greatly amplifying perturbations through mechanisms analogous to positive feedback in mechanical systems with the single greatest influence being the percentage of the population living in poverty. Given the New York region's overwhelming dominance of national patterns for the hierarchical diffusion of disease and disorder this result has significant policy implication. More explicitly, lowering the rate of poverty in and near New York City would markedly reduce the vulnerability of the United States to emerging infection.